OB says I need Continuous Fetal Monitoring for VBAC, any advice?

[canadianmum]

My twins were born by C-section at 32+5 due to severe pre-eclampsia so I have never been in labour. This time I am having one baby, have no signs of pre-eclampsia and am already 37+4. So I told the consultant (his dogsbody) that I wanted a VBAC and he was cool with that, but says I must have Continuous Fetal Monitoring from 3-4cm dilation, due to tiny risk of uterine rupture.

Anyone else been told this? Can I say no? Has anyone had successful VBAC at home or in a birth centre under similar circumstances?

why would you want to say no?

I agree. Why would you want to say no? I have had 2 VBACS and in the 2nd case thank god I had monitoring as I was that close to rupturing. The risk may be tiny but I was almost that one. We had already lost one baby and my DH thought he was about to lose the other and his wife. It really is non intrusive and TBH it culd save your life. Give birth up on your knees leaning over the back of the bed and you won't even know it is there.

i dont think you need continuous monitering, i know a woman who had a home birth vbac

they tried to insist on continuous monitering for me as my babies were very overdue 17days late.

anyway if you have a number of 20min traces etc and they show that you and the baby are fine then no you shouldnt need constant monitering, they can then use a hand held moniter every ten mins or so to check the babies heartbeat, if the midwife has any concerns they can put you on the moniter again for a short period.

i would try and avoid continuous monitering if you and the baby are well as it means you cannot move around and be upright, making labour more painful and likely to last longer, lead to more intervention etc, the " cascade of intervention".

good luck, xxx

Forgot to say, the monitoring is from when you start to push. Not for the whole of labour.

i moved around and was in lots of positions when I was monitored. I think you'd be bonkers to refuse an expert's advice which is after all intended to protect your health and that of your child.

My first was delivered at 32 weeks due to severe pre eclampsia so I was in a similar position to you.
2nd time round I was in labour for almost 4 days. Finally at 7cm they took me into hospital, gave an epidural and started to monitor things.
Eventually had another emergency CS because the labour was progressing so slowly and DS was in distress.

I would have killed to have been admitted at 3-4cm for fetal monitoring! .

I agree with bundle...what good reason could you have to refuse?

you can refuse constant monitoring, indeed, there is a fair bit of research to show it does not actually change the outcome...also, intermittent monitoring, and good observations from a MW can also pick up any signs of rupture

i stayed at home as long as i could when going for VBAC, and was mobile as long as possible.. not sure if you are still in canada..if not then contact AIMS or homebirth association here for more help

I had continuous monitoring for my first labour and was able to move around without any bother.

some decelerations were picked up by our monitor when I had dd1 and i asked for a scalp blood test (from her) and she was acidotic, so i had an emergency c/s. it's sensible use of available technology, imo.

No you don't need be continually monitored. You should look on the AIMS site for more info. Also... Lulumama will be here soon. What she doesn't know is probably not known.

ah........ there she is!

also, canadianmum, if you search on here, then you will find some excellent info from Klaw, DaisyMOO and hopefully myself, about VBAC and CFM..

at the end of the day, you can make an informed decision to accept or decline anything offered to you in childbirth

interesting that people have had continuous monitering and been able to move around, i ha dit with ds1, and it was a pita, obvioulsy you cant go in the bath or birth pool, my main form of pain releif for labour.

and whenever i moved aroudn the moniter pads would often move etc and then the midwife would have to fiddle around trying to find the babies hearbeat again, a complete pain, esp as i hate people touching me during labour.

i have read quite widly on childbirth and had a doula last time round, from the research i have done continuous monitering is not any better at picking up problems infact it often leads to unnecessary intervention.

Let's be clear about continuous fetal monitoring - all the evidence (from 'normal' labours shows that it does not improve average outcomes for mother and baby but does increase the likelihood of needing a cesarean. With VBACs there is some evidence that it may pick up impending scar rupture. However it could also theoretcially increase the likelihood of scar rupture in the first place if it restricts the mother's movement,decreases mobility, or makes the mother feel 'observed' thus increasing the length of labour.

Whilst some people may find they are able to move around whilst on the monitor, many others find themselves restricted to bed and once you are on the monitor it can be very difficult to get the medics to 'agree' to take it off. The risk of uterine rupture is 0.35% and fetal heart monitoring is not a failsafe way of detecting rupture - not all babies' heartrates will be affected immediately and interpreting CTGs in an inexact science. Other ways to keep an eye out for rupture include monitoring the maternal pulse rate, intermittant ausculation and watching out for signs such as sudden cessation of contractions and/or abdominal pain between contractions. Anecdotally I know of a couple of women whose scar rupture went undetected for some time because the 'monitor' said everything was fine.

On the other hand, if you would prefer to be monitored and feel that the benefits outweigh any negatives then it is a good idea to try and get some agreement in advance that you will be 'allowed' off the bed and investigating the possibility of telemtry (or wireless) continuous monitoring - many units have them but leave them in the cupboard unless someone requests them You could also consider some sort of compromise whereby you spend 20 minutes on the monitor every hour or two. Whatever you decide is your decision and no one can force you to do anything.

Lulumama/Mars

Could you please direct me to the place on the AIMS website or the relevant research that says that CFM is not beneficial, leads to more intervention etc. I am ready to go any day and BP has just gone up so would like to print it out and take it with me as I suspect the doctors will try and persuade me to have CRM which I really don't want. I can't find a succinct bit of AIMS.

Many thanks - you are inspirational!

and DaisyMOO, sorry.

I had continuous monitoring for my VBAC and ended up with spinal block and genital mutilation to birth a baby with APGARS of 9 and 9.

I found it very difficult to change position on a bed that felt about 1 foot wide and we had to 'sort out' the wires for the CTG, the boost button and TENS machine in one hand and the G&A in the other. It was such a palaver and so annoying..... I was never relaxed and felt alone on my pedestal while mw and dp were separate from me.

If I wasn't on the blasted bed cos of CTG and free to move things probably would have been very different.

Yesterday I was with a very well researched VBA3C lady while she laboured at home until eventually she 'needed drugs!'. She was very worried about going to the hospital too early but we went when we did at about 9am, contractions having started about 1am, We arrived at the hospital and once we were in and temp, pulse etc was taken it became time to check baby, the hand held check sounded worrying so mw got the CTG straps on, initial reading was reasonable but within a couple of contractions the HR was staying far too low after each contraction so she had a VE and was found to be only 3cms. There had been no constant pain, or blood loss, or waters or anythign before this. She was taken immediately for a crash section, baby was found in abdomen with APGARS of 2 and 7. This is when I witnessed the fabulousness of the NHS! They moved like lightening, baby was revived and doing far better than was expected. Time will tell if any lasting damage was done. Mum came through the surgery well, but shocked!

A baptism of fire, reminder of the serious but tiny risk of Uterine Rupture and the importance of a Vigilant Midwife for me. However, I still believe that intermittant monitoring and careful observations of mum will tell if CTG is required should there be worrying signs and then let the medical profession do what it can do best if it is needed.

Say a little prayer for my lady's baby if you are that way inclined, please!

Yes I hated that getting tangled up sensation last time - it was awful. And every time I tried to change position the pads slipped and the mw started panicing about decels when it was just my hb. Nightmare. Surely there is room for a compromise with intermittent and maybe some CFM here and there to check or if anything seems amiss.

i had continual monitoring during my vbac from the time i was on delivery suite. i was only there 2 hours and dd was born! and i was up and moving around with the thing attached to me. the wires a re quite long so you can kind of take them with you iyswim

Daisymoo - thank you so much for the information, you are obviously very well informed about this! I had a lot of monitoring when in hospital with my last section and I hated it, felt chained to the bed.

lulumama - I am here in good old Blighty, hoping for a straightforward VBAC! Thank you for your wise words .

Of course I don't want to do anything to endanger my baby but no one seems to agree that CFM improves the outcome anyway so what's the point? My (independent) midwives will listen to the baby's heartbeat every 15mins and that seems enough to me. If something doesn't sound right then they listen more often and if still not right then they set up the continuous monitor, surely that should be good enough??

barbarmama...might not be in AIMS, might be in Cochrane report.. i forget...Daisy knows....

Sorry I missed several posts while trying to draft my own.

Klaw - thank you for your story, I hope the baby and mum make a full recovery. I like to think that if I have midwives with me at all times and intermittent monitoring then we will be able to quickly pick up anything like that.

barbaramama - I agree, surely compromise is the key and the doctors and midwives would like to avoid unnecessary intervention, but it seems like they just have one policy and they stick to it, no matter what the research or common sense says. Very frustrating. They have also told me that it is dangerous to have a gel or drip induction due to the risk of rupture; I am totally happy with that policy, it makes sense to me, unlike the CFM policy.

Not sure if it is relevant but my C-section was 4.5 yrs ago and scar has healed beautifully. I wonder if that makes any difference??

The most recent Cochrane Review Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour

When trying to argue your case AGAINST monitoring:
Electronic fetal monitoring Is not necessary for low risk labours
and
Birth can be a hazardous journey: electronic fetal monitoring does not help.

Mary Cronk's scar monitoring procedures

these are some of the links I post on another forum. HTH

Good luck Can Mum, I have no experience of CS or VBACS, sorry to hijack your post. Hope you get the answers you need.

Thank you Klaw!